title: Alveolar hemorrhage and kidney disease: characteristics and therapy.
abstract: Anti-neutrophil cytoplasmic antibody-associated vasculitis and Goodpasture's glomerular basement membrane disease are the most common causes of diffuse alveolar hemorrhage, a life-threatening disease. Systemic lupus erythematosus and the antiphospholipid syndrome are also causes of alveolar hemorrhage. We retrospectively reviewed 15 cases of diffuse alveolar hemorrhage (DAH) associated with renal diseases. Diagnosis of DAH was based on the presence of bloody bronchoalveolar lavage fluid. There were three men and 12 women, with a mean age of 50.5 years (extremes: 24-74 years). Proteinuria and hematuria were observed, respectively, in 15 and 14 cases. Six patients revealed arterial hypertension. Crescentic glomerulonephritis was diagnosed with kidney biopsies in ten cases. The etiology of renal disease was microscopic polyangiitis (MPA) in seven cases, Wegener disease in four cases, systemic lupus erythematous in one case, cryoglobulinemia in one case, myeloma in one case and propyl-thiouracil-induced MPA in one case. Hemoptysis occurred in 14 cases. The mean serum level of hemoglobin was 7.1 g/dL (5.1-10 g/dL). The mean serum creatinine concentration was 7.07 mg/dL (2.4-13.7 mg/dL). Gas exchange was severely compromised, with an oxygenation index <80 mmHg in 14 patients and <60 mmHg in seven patients. Bronchoalveolar lavage was performed in 11 cases, and had positive findings for hemorrhage in all. Methylprednisolone pulses and cyclophosphamide were used in 14 patients. Plasmapheresis was performed in three cases. One patient received cycles of Dexamethasome-Melphalan. Three patients died as a result of DAH. The mortality rate in our study was 20%.
authors.affiliation: Department of Nephrology, La Rabta Hospital, Tunis, Tunisia. lilia.benfatma@rns.tn
authors.forename: Lilia Ben
authors.initials: LB
authors.lastname: Fatma
authors.forename: Zohra
authors.initials: Z
authors.lastname: El Ati
authors.forename: Rais
authors.initials: R
authors.lastname: Lamia
authors.forename: Dorra Ben
authors.initials: DB
authors.lastname: Aich
authors.forename: Krid
authors.initials: K
authors.lastname: Madiha
authors.forename: Smaoui
authors.initials: S
authors.lastname: Wided
authors.forename: Hedi Ben
authors.initials: HB
authors.lastname: Maiz
authors.forename: Somaya
authors.initials: S
authors.lastname: Beji
authors.forename: Zouaghi
authors.initials: Z
authors.lastname: Karim
authors.forename: Fatma Ben
authors.initials: FB
authors.lastname: Moussa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli; D012189:Retrospective Studies; D055815:Young Adult